The bladder is located down in the pelvis just in front of the rectum and serves as a reservoir for storage of urine. When things are working properly, the kidneys will empty their contents through the ureter into the bladder where the urine is stored for several hours before emptying. The bladder plays a key role in the urinary tract in that it keeps urine flowing in the proper direction, not allowing it to flow backwards into the kidneys, and ensures that the urinary tract is emptied of contents periodically. If for some reason the bladder does not function properly, or if it develops infection, stones, or tumors, the urologist is asked to treat these conditions.
Bladder infection or cystitis is very common in women because the urethra, a conduit for urine to leave the body, is short and allows relatively easy access of bacteria up into the bladder from the outside. Normally these bacteria are washed out of the bladder during voiding, but occasionally, they remain causing infection and symptoms. In males, cystitis is less common since the urethra is longer and the bladder is further away from the outside of the male body.
Interstitial Cystitis (IC) is a chronic bladder disorder also known as painful bladder syndrome or frequency-urgency-dysuria syndrome. IC occurs more often in females, usually between the ages of 20-65. In the beginning, symptoms closely resemble recurrent or chronic bladder infection, but often bacteria typically found in urinary tract infections are not cultured. In this disorder, the bladder wall can become inflamed and irritated. It seems most probable that the cause of IC may be an autoimmune reaction in which the body's defense system targets normal bladder tissue. The inflammation can lead to scarring and stiffening of the bladder, decreased bladder capacity, pinpoint bleeding and in rare cases, ulcers in the bladder lining. For more information on this subject click here.
Bladder stones are not nearly as common as they used to be because of improvements in nutrition and early recognition and treatment of bladder neck and ureteral obstruction.
Bladder cancers arise on the inside of the bladder wall. The fragile cancerous tissue often presents as blood in the urine, called hematuria. Hematuria can either be visible or many times can only be detected by dipstick or microscopically. The bleeding often stops by itself and the urine may be clear for several weeks or months as the tumor continues to grow. The cancer often stays confined to the inside of the bladder wall and can be removed surgically. These cancers were at one time found much more often in men than women, but they are becoming more common in women because more women are smoking. Cigarette smoking or chemical exposure often causes bladder tumors and kidney tumors.
A dysfunctional bladder that cannot store urine properly can result in incontinence or leakage of urine at inappropriate times. Causes can include neurologic diseases, diabetes and changes that occur after childbirth. The treatment of incontinence will depend on the cause.
When asked to examine a patient with bladder problems, the urologist will often use the same studies that he or she uses to evaluate the kidneys, for example, a urinalysis and x-rays. It is not uncommon for a urologist to recommend direct inspection of the bladder with a scope to rule-out tumors, stones or other potential problems.
Treatment of various diseases of the bladder can be medical (i.e. treatment of an infection with antibiotics) or surgical. For example, bladder stones can be broken up with either laser treatment or shock wave treatment. Superficial bladder tumors may be removed using a scope, but tumors that grow deeply into the muscle of the bladder may necessitate removal of the entire bladder and require creation of an alternative route for drainage of urine. One very common operation performed by urologists is re-suspension of the bladder in women who are experiencing incontinence and bladder prolapse that medicine and conservative measures cannot help.